EHR Chapter 6

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Across
  1. 4. The process of contacting the insurance carrier and receiving validation of coverage for that patient, deductible status, and co-pay amount.
  2. 5. Accounts ________ Monies being paid from the medical practice
  3. 6. Medical _______ The fact that there is a medical reason to perform a procedure or service.
  4. 7. Explanation of _________/EOB An explanation of the charges for services, the amount paid by the insurance company, and the amount due by the subscriber, which is sent to the subscriber
  5. 10. Accounts ________ Monies coming into a medical practice
  6. 12. Intentional deception, which in healthcare takes advantage of a patient, or an insurance company
  7. 13. Coding system required by Medicare and Medicaid to document services and procedures. Acronym for Healthcare Common Procedure Coding System
  8. 15. A form of cost-sharing in which the insurance carrier pays a percentage of the claim and the patient pays the remaining percentage.
  9. 16. The amount due from the patient at the time of the office visit
  10. 18. __________ diagnosis -The reason, after study, determined to be chiefly responsible for the patient’s admission to the hospital.
  11. 19. Lists the services and procedures by CPT® code and description of the service, provided by a healthcare facility along with the charge for each service.
Down
  1. 1. A formal, written document that describes how the hospital or physician’s practice ensures rules, regulations, and standards are being adhered to.
  2. 2. ___________ advice (RA)-A detailed accounting of the claims for which payment is being made by an insurance company; usually accompanies the payment.
  3. 3. The out-of-pocket payment amount that a policyholder must meet before insurance covers the service
  4. 8. Posting of charges and the payment of claims in the practice management system to update patients’ accounts.
  5. 9. The primary person covered by an insurance plan.
  6. 11. The process of reviewing claims by the insurance carrier to determine payment.
  7. 14. On an insurance claim, the relationship between each procedure and a diagnosis to demonstrate medical necessity.
  8. 17. _______ Care Act Signed into law in 2010, the ACA resulted in improved access to affordable healthcare coverage and protection from abusive practices
  9. 20. Coding and billing that is inconsistent with typical coding and billing practices